Request a consultation with a Transform Destiny Master Practitioner/Coach

Please consider my application for for a one-on-one session and, if accepted, contact me to book my appointment for a consultation call to find out if I'm a good fit one of these sessions. On this call, we will discuss what your desired outcomes are, what options we have for types of session for you, and what the investment would be for that session or sessions.

All consultation calls and sessions are done in a professional manner over the internet in a secure and completely private fashion. Doing sessions over live, streaming internet is 100% as effective as in-person sessions, and much more convenient for both you, as the client, and the Practitioner.

Please complete this confidential profile and submit it us as soon as possible. It is important that you be as thorough as possible in explaining all aspects of the topic you wish to have a session about.

Please submit your completed form by hitting the "Send Consultation Request" button at the bottom of the form. In order to protect your privacy, DO NOT EMAIL THIS INFORMATION. This form is 100% secure using the strongest, most up-to-date encryption technology standardized on the internet today. Submit your information by hitting the "Send Information Now" button once. Either way, we recommend that you print out a copy of your completed form for your records before hitting the send button.

Personal Information

Client Name

Client Age

Name of Parent(s) or Guardian(s) (req'd if Client is under 18)

Contact Information

Primary Email

Primary Phone

Mobile Phone

Address 1

Address 2

City

State

Postal Code

Country

Please describe any previous experiences with NLP, Hypnosis, Coaching, EFT or Reiki:

In your own words, please describe any significant emotional events during the most recent 3 years:

Is the client currently under the care of a physician, psychotherapist, pathologist, or any other licensed practitioner for this issue?

If yes, please explain the condition(s) for which the client is being treated and the nature of the treatment(s), including any medications:

Please include any additional information which you believe may be relevant to the current struggle(s):

Please describe as clearly as possible the results that you (the client) would like to achieve:

Thank you for completing your information profile. Please take a moment to review your answers and add any information that you feel is relevant to achieving your desired results. By clicking the "Send Information Now" button, you agree to the Enrollment and Cancellation agreement for one-on-one and breakthrough sessions, should you book an appointment at a future date.

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For NLP or Hypnotherapy Sessions

Personal Information

Contact Information

Information Request

Transform Destiny Professionals for One-On-One Services

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